Impact of Different Pacing Modes on Left Ventricular Function Following Cardiopulmonary Bypass

Dzemali, Omer; Bakhtiary, Farhad; Cw, Israel; Ackermann, Hanns; Moritz, A.; Kleine, Peter

doi:10.1055/s-2007-989395

Cited by 15 publications

(8 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Importantly, this is not associated with changes in myocardial energy demand (21), unlike most inotropic agents, which improve contractility at the expense of increased oxygen consumption and energy store depletion (29). Acute functional benefit without increased energy cost makes BiVP an excellent option for treatment of postoperative ventricular failure, and initial studies have shown its utility after cardiac surgery (14,20,23,24,33).…”

mentioning

confidence: 99%

Simultaneous variation of ventricular pacing site and timing with biventricular pacing in acute ventricular failure improves function by interventricular assist

Quinn

Cabreriza²,

Richmond

et al. 2009

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

The goal of this work was to investigate the hemodynamic effects of simultaneous left ventricular (LV) pacing site (LVPS) and interventricular pacing delay (VVD) variation with biventricular pacing (BiVP) during acute LV failure. Simultaneously varying LVPS and VVD with BiVP has been shown to improve hemodynamics during acute right ventricular (RV) failure. However, effects during acute LV failure have not been reported. In six open-chest pigs, acute LV volume overload was induced by regurgitant flow via an aortic-LV conduit. Epicardial BiVP was implemented with right atrial and ventricular leads and a custom LV pacing array. Fifty-four LVPS-VVD combinations were tested in random order. Cardiac output was evaluated by aortic flow probe, ventricular systolic function by maximum rate of ventricular pressure change, and mechanical interventricular synchrony by normalized RV-LV pressure diagram area. Simultaneous LVPS-VVD variation improved all measures of cardiac function. The observed effect was different for each functional index, with evidence of LVPS-VVD interaction. Compared with effects of LVPS-VVD variation in a model of acute RV failure, hemodynamic changes were markedly different. However, in both models, maximum rate of ventricular pressure change of the failing ventricle was improved with synchronous interventricular contraction, suggesting that, in acute ventricular failure, BiVP can recruit the unstressed ventricle to support systolic function of the failing one. Thus simultaneously varying LVPS and VVD with BiVP during acute ventricular failure can improve cardiac function by "interventricular assist", with hemodynamic effects dependent on the type of failure. This supports the potential utility of temporary BiVP for the treatment of acute ventricular failure commonly seen after cardiac surgery.

show abstract

mentioning

confidence: 99%

Simultaneous variation of ventricular pacing site and timing with biventricular pacing in acute ventricular failure improves function by interventricular assist

Quinn

Cabreriza²,

Richmond

et al. 2009

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

show abstract

“…They concluded that only 9 of the 13 publications, resulted in significant increases of cardiac index,up to 22% with BiVP or AR-LVP. Tanaka et al and others [18,22,23] observed greatest benefits in patients with low EF and wide QRS complex. Whereas others, report no significant hemodynamic improvement with these pacing modes or even no adverse effects with RA-RVP in populations with normal ventricular function [19-21].…”

Section: Discussionmentioning

confidence: 99%

“…The strategy for perioperative optimization, by means of LVP or BiVP using a LV basal cathodal electrode and adequate adjustments of AVD and VVD if feasible, is gaining progressive acceptance, to improve CO perioperatively, particularly in cases with depressed EF and LBBB [11,13,18,23]…”

Section: Discussionmentioning

confidence: 99%

Temporary epicardial left ventricular and biventricular pacing improves cardiac output after cardiopulmonary bypass

García-Bengochea

Teijeira-Fernández

Calvelo

et al. 2012

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundTo evaluate, with different pacing modes, acute changes in left ventricular systolic function, obtained by continuous cardiac output thermodilution in various subsets of patients undergoing cardiopulmonary bypass surgery. Increments of mean arterial pressure and cardiac output were considered the end point.MethodsFifty cases electively submitted to cardiac surgery were analyzed. Isolated valve surgery 62%, coronary revascularization 30% and 8% mixed disease. Left ventricular ejection fraction was preserved in 50%,36% had moderate depression,(EF 36%-50%) whereas 14% had severe depression (EF < 35%). Left bundle branch block occurred in 18%. Preoperatively 84% were in sinus rhythm and 16% in atrial fibrillation. The different subgroups were analyzed for comparisons. Right atrial-right ventricular and right atrial-left ventricular pacing were employed in sinus rhytm. Biventricular pacing was also used in atrial fibrillation.ResultsRight atrium-right ventricular pacing, decreased significantly mean arterial pressure and cardiac output (2.3%) in the overall population and in the subgroups studied. Right atrium-left ventricle, increased mean arterial pressure and cardiac output in 79% of patients and yielded cardiac output increments of 7.5% (0.40 l/m) in the low ejection fraction subgroup and 7.3% (0.43 l/m) in the left bundle branch block subset. In atrial fibrillation patients, left ventricular and biventricular pacing produced a significant increase in cardiac output 8.5% (0.39 l/min) and 11.6% (0.53 l/min) respectively. The dP/dt max increased significantly with both modes (p = 0.021,p = 0.028).ConclusionRight atrial-right ventricular pacing generated adverse hemodynamic effects. Right atrium-left ventricular pacing produced significant CO improvement particularly in cases with depressed ventricular function and left bundle branch block. The greatest increments were observed with left ventricular or biventricular pacing in atrial fibrillation with depressed ejection fraction.

show abstract

“…The effects of temporary BiVP after cardiac surgery and benefits in low output states are not well defined [6-13]. Benefits of BiVP optimization in this setting are unknown [14-23].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Stability During Biventricular Pacing After Cardiopulmonary Bypass

Spotnitz

Wang

Quinn

et al. 2011

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

Objective-To assess stability of cardiac output, mean arterial pressure, and systemic vascular resistance during biventricular pacing optimization.Design-Substudy analysis of data collected as part of a randomized controlled study examining the effects of optimized temporary biventricular pacing after cardiopulmonary bypass.Setting-Single center study at a university affiliated tertiary care hospital. Participants-Cardiac surgery patients at risk of left ventricular failure following cardiopulmonary bypass (CPB).Interventions-Biventricular pacing was optimized immediately after CPB. Atrioventricular delay (7 unique settings) was optimized first, followed by left ventricular pacing site (3 unique settings), followed by interventricular delay (9 unique settings) Each setting was tested twice for 10 seconds each time. Vasoactive medication and fluid infusion rates were held constant. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Measurements and Main Results-Aortic NIH Public Access

show abstract

Impact of Different Pacing Modes on Left Ventricular Function Following Cardiopulmonary Bypass

Abstract: In the majority of patients with reduced LV function, temporary biventricular pacing improves CO and arterial blood pressure after surgery, especially when LV dilatation is present.

Cited by 15 publications

References 7 publications

Simultaneous variation of ventricular pacing site and timing with biventricular pacing in acute ventricular failure improves function by interventricular assist

Simultaneous variation of ventricular pacing site and timing with biventricular pacing in acute ventricular failure improves function by interventricular assist

Temporary epicardial left ventricular and biventricular pacing improves cardiac output after cardiopulmonary bypass

Hemodynamic Stability During Biventricular Pacing After Cardiopulmonary Bypass

Contact Info

Product

Resources

About